The mechanical view on the human body may be considered as the context in which the highly technological medicine of these days originated. Organ transplantation is certainly one of the most impressive possibilities of this new evolution in medical technology. It exists by the grace of the paradigm of the body as a “Körper” : this paradigm leads to a self-evident acceptance of transplantation medicine in its most brilliant applications. Refinement of surgical techniques, better preservation of organs, the development of (...) more effective immunosuppressives, better procedures for the establishment of brain death criteria and better criteria for the selection and matching of donors and receptors are immanent goals of this type of medicine. Meanwhile the lives of many thousands of patients are saved and these patients even receive the chance for a new life, with much more quality. The ethical reflection on organ transplantation has followed rather rapidly this technical discourse and sounds as a kind of “moral engineering”. This is certainly connected with the upcoming success of “Principlism” , whereby medical decision making is oriented by applying four major principles to medical cases . It is also connected with the ethical approach of utilitarianism, which fits almost perfectly in this technological atmosphere. The authors question this approach and suggest that a more relational understanding of the human body as “Leib” would be a better paradigm for the promotion of solidarity in the context of organ donation and transplantation. Human beings do not only ‘have’ a body, but ‘are’ also their body. The body of the deceased refers to the life of a loved one. Technical procedures surrounding organ removals sometimes hinder the possibility for the family to bereave adequately around their loved one. The authors are convinced that the urging problem of organ shortage is not only caused by lack of solidarity or laziness, but also by the reductionist discourse of transplantation medicine itself. They suggest that we have to find – eventually with the help of poets and writers – an adequate new language to replace the alienating discourse of current transplantation medicine. They see also in communitarianism and personalist care ethics a better ethical approach for touching the peculiar sensitivities of eventual donors and receptors. (shrink)

The shortage of available organs for transplantation, organ tourism and illegal kidney transplantations put the question of paid organ donation and commercialism high on the agenda. Ethicists as J. Radcliffe-Richards and R.Veatch have reopened the debate. Therefore it is necessary and useful to check the main arguments pro and con. The advocates of paid organ donation refer to autonomy and pragmatic considerations. Why not regulate an ineradicable practice? The opponents rely on the dignity and integrity of the human body and (...) on justice. They are afraid of exploitation of the poor. A thorough analysis of the debate reveals that the arguments pro and con are incompatible and that the ethical debate leads nowhere. Furthermore, paid organ donation will stimulate the instrumentalisation and commodification of the human body. It brings about a further medicalisation of society where the wishes of the patient and the ‘cure’ prevails over the ‘care’, prevention of organ failure and scientific research . On the basis of the ethical impasse and especially on the basis of these implicit sociological considerations we make a plea against paid organ donation. Altruistic donation and solidarity must remain the basis of organ transplantation. Solidarity is fed by charity and fraternity , the two great sources of western culture and morality. These also must remain the basic inspiration of medicine in general and of organ transplantation in particular. (shrink)

Presumed consent alone will not solve the organ shortage, but it will create an ethical and legal context that supports organ donation, respects individuals who object to organ donation, relieves families from the burden of decision making, and can save lives.

In the early days of organ transplantation from deceased donors, the surgical team would bring the donor into the operating room with the recipient, the respirator would be stopped, and the team would wait for the donor’s heart to cease beating. This type of organ donation has been defined as donation after cardiac death, also referred to as non-heart-beating donation. These donors were not declared dead using neurological criteria, but rather using conventional cardiorespiratory criteria. In 1959, Mollaret and Goulon coined (...) the term “coma dépassé” for the patients with an irreversible state of coma and apnea. Jean Morelle and Guy Alexandre of the Catholic University of Louvain, Belgium, were the first to introduce a set of brain death criteria based on the description of coma dépassé, and carried out, in 1963, the first transplants from a brain dead donor in their country and in the world. (shrink)